Creating an inviting perioperative learning experience

AORN Journal,  Feb, 2007  by Tess M. Pape

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Local hospitals are experiencing a shortage of perioperative nurses, and it is common knowledge that perioperative managers across the United States are looking for innovative ways to improve recruitment and retention of perioperative nurses. In addition, the average age of perioperative nurses has been increasing steadily, and many perioperative nurses are retiring. (1) This situation provides a rationale for seeking creative changes in nursing education and in how nursing students and new, younger perioperative nurses are treated.

Younger nurses can be valuable members of a perioperative team. Their positive attributes include being focused, having a desire to succeed as professionals, and wanting to make a difference in the world. They usually have computer and technical knowledge, which is quite useful in the perioperative setting. Years ago, perioperative skills were learned in nursing schools as part of the curriculum, but today this usually is not the case. (2) This is all the more reason for experienced perioperative nurses and teachers to help young nurses realize that there are many advantages to becoming a perioperative nurse. Thus, an elective perioperative course has evolved within the baccalaureate nursing program associated with three universities in Abilene, Tex.

This elective course previously had been taught using a different approach and incorporating fewer clinical hours at another hospital. In past semesters, students spent three clinical days in the OR during a 15-week semester. When a new faculty member began teaching the course, however, the clinical time was increased to five days in the OR and the course was revised. This faculty member undertook an educational project to examine the usefulness of invitational theory (ie, a model for using positive behaviors) as a teaching strategy to improve adult learning in both the clinical OR and classroom settings.

PERIOPERATIVE CLINICAL EXPERIENCES

Previous efforts have been made to increase interest in perioperative nursing. For example, Project Alpha was developed by AORN in the 1980s to foster students' curiosity about perioperative nursing by including perioperative subject matter in nursing school curricula. (3) In March 2006, the AORN House of Delegates ratified the "AORN position statement on the value of clinical learning activities in the perioperative setting in undergraduate nursing curricula," which supports the need for more perioperative courses in undergraduate nursing programs. (4)

Often, schools of nursing offer only one day of observation in the OR with few hands-on opportunities. Perioperative experiences that include more than just observation, however, can provide students with a vast array of critical thinking skills that can be applied to other areas of nursing. (2) A recent study showed higher surgical nursing knowledge scores for students who were assigned to perioperative settings compared to students who had typical medical-surgical nursing unit experiences. (5) This indicates that the perioperative area has been mistakenly overlooked for providing valuable learning experiences for nursing students. Nursing students can learn much more in the perioperative setting than some nursing faculty members may realize. Some of the skills and knowledge that nursing students can learn in the perioperative setting are included in Table 1.

Other evidence supports the success of collaborative relationships with nurses in the perioperative setting in developing young nursing students' skills for working in the OR. Hospitals that facilitate perioperative coursework help to transition nursing students into the role of full-time employees, (6) which benefits everyone involved.

Some of today's perioperative nurses, however, are still "toxic" to those who are new to the area. These toxic nurses think others should have to learn like they did--the hard way. They continue to exhibit negative attitudes in the perioperative environment, especially toward new nurses, which can lead to students and new nurses choosing not to work in the perioperative environment. This paradigm must be changed because perioperative nurses are in demand. Perioperative nurses must be willing to model the behavior they wish to see in others and treat nursing students and other nurses with respect and caring/

INVITATIONAL THEORY

Adults tend to demonstrate an increase in learning when they are participants in their own learning process. (8) Better learning outcomes are more likely, therefore, if students feel invited and welcome in the classroom and clinical setting.

Invitational theory has been used as an educational framework to examine characteristics of the helping/learning relationship between preceptor and preceptee. The two basic ideas within invitational theory are the perceptual tradition and self-concept theory. According to the perceptual tradition, people act in accordance with their perceptions of the world and how things work. Self-concept theory considers a person's perceptions of his or her past experiences as important controls for current behavior. (9) Invitational theory blends these concepts into methods that help a person feel a sense of unconditional acceptance from another person.